<!-- 情報誌のご案内入力画面 -->
	<div id="main">
		<h1 id="specialTitle">{$contentsTitle}</h1>
		<div id="siteContents">
			<p class="categoryTitle">情報誌案内</p>
			<h1>送付申し込みフォーム</h1>
			<div id="contentsBlock">
				<!-- contents -->
				<div id="contents">
					<div id="sendMagazineForm">
						<div class="h2CmBlock01">
							<h2><span>お届け先情報入力</span></h2>
						</div>
						<p class="tableLead">現在お住まいの地域以外の情報誌「アパマンショップ」をご希望の方は、初回のみ無料にてお届けいたします。
						２回目以降のお問合せにつきましては送料をご負担いただきますのであらかじめご了承下さい。
						なお、(株)アパマンショップネットワーク以外が発行する情報誌につきましては、各版の発行元へお問合せください。</p>
						<table id="inqAllTable">
				        	<tr>
				        		<th>送付希望情報誌&nbsp;<span>[必須]</span></th>
					        	<td>
								<p>
								<select name="SoufuKibouJyouhoushi" id="SoufuKibouJyouhoushi" class="required" >
									<option value="" {if $SoufuKibouJyouhoushi == ""} selected="selected" {/if}>--選択してください--</option>
									<option value="1"{if $SoufuKibouJyouhoushi == "1"} selected="selected" {/if}>札幌版</option>
									<!--<option value="2"{if $SoufuKibouJyouhoushi == "2"} selected="selected" {/if}>盛岡版</option>-->
									<!--<option value="4"{if $SoufuKibouJyouhoushi == "4"} selected="selected" {/if}>仙台・宮城版</option>-->
									<!--<option value="5"{if $SoufuKibouJyouhoushi == "5"} selected="selected" {/if}>新潟版</option>-->
									<!--<option value="6"{if $SoufuKibouJyouhoushi == "6"} selected="selected" {/if}>長野版</option>-->
									<option value="24"{if $SoufuKibouJyouhoushi == "24"} selected="selected" {/if}>滋賀版</option>
									<!--<option value="19"{if $SoufuKibouJyouhoushi == "19"} selected="selected" {/if}>松山版</option>-->
									<!--<option value="20"{if $SoufuKibouJyouhoushi == "20"} selected="selected" {/if}>福岡版</option>-->
									<!--<option value="21"{if $SoufuKibouJyouhoushi == "21"} selected="selected" {/if}>長崎県版</option>-->
									<option value="22"{if $SoufuKibouJyouhoushi == "22"} selected="selected" {/if}>大分版</option>
									<option value="23"{if $SoufuKibouJyouhoushi == "23"} selected="selected" {/if}>熊本版</option>
								</select>
	  							</p>
								<p class="errTxt" htmlfor="SoufuKibouJyouhoushi" generated="true" />
								</td>
					   		</tr>
				        	<tr>
				        		<th>お名前&nbsp;<span>[必須]</span></th>
					        	<td>
								<p>（姓）<input name="NameSei" id="NameSei" value="{$NameSei}" type="text" maxlength="10" class="nameInput required zenkaku" style="IME-MODE: active" />&nbsp;&nbsp;（名）<input name="NameMei"  id="NameMei" value="{$NameMei}" type="text" class="nameInput required zenkaku"  maxlength="10" style="IME-MODE: active" /></p>
								<p class="errTxt" htmlfor="NameSei" generated="true" />
								<p class="errTxt" htmlfor="NameMei" generated="true" />
								</td>
					   		</tr>
				        	<tr>
				        		<th>フリガナ&nbsp;<span>[必須]</span></th>
					        	<td>
								<p>（セイ）<input name="KanaSei"  id="KanaSei" value="{$KanaSei}" type="text" class="nameInput required furikana"  maxlength="10" style="IME-MODE: active" />&nbsp;&nbsp;（メイ）<input name="KanaMei" id="KanaMei" value="{$KanaMei}" type="text" class="nameInput required furikana"  maxlength="10" style="IME-MODE: active" /></p>
								<p class="errTxt" htmlfor="KanaSei" generated="true" />
								<p class="errTxt" htmlfor="KanaMei" generated="true" />
								</td>
					   		</tr>
							<tr>
								<th>年齢</th>
								<td>
								<select name="AgeKbn" id="AgeKbn">
									<option value="0" {if $AgeKbn == "0"} selected="selected" {/if}>選択してください</option>
									<option value="1"{if $AgeKbn == "1"} selected="selected" {/if}>18歳未満</option>
									<option value="2"{if $AgeKbn == "2"} selected="selected" {/if}>20歳未満</option>
									<option value="3"{if $AgeKbn == "3"} selected="selected" {/if}>20～24</option>
									<option value="4"{if $AgeKbn == "4"} selected="selected" {/if}>25～29</option>
									<option value="5"{if $AgeKbn == "5"} selected="selected" {/if}>30～34</option>
									<option value="6"{if $AgeKbn == "6"} selected="selected" {/if}>35～39</option>
									<option value="7"{if $AgeKbn == "7"} selected="selected" {/if}>40～49</option>
									<option value="8"{if $AgeKbn == "8"} selected="selected" {/if}>50～59</option>
									<option value="9"{if $AgeKbn == "9"} selected="selected" {/if}>60歳以上</option>
								</select>
								</td>
							</tr>
							<tr>
								<th>性別</th>
								<td>
									<input type="radio" name="Sex" id="Sex0" value="0"  {if $Sex == "0"} checked {/if}/>
									<label for="sex1">男性</label>
									<input type="radio" name="Sex" id="Sex1" value="1" {if $Sex == "1"} checked {/if} />
									<label for="sex2">女性</label>
								</td>
							</tr>
							<tr>
								<th>結婚</th>
								<td>
									<input type="radio" name="Mrrg" id="Mrrg0" value="0"  {if $Mrrg == "0"} checked {/if}/>
									<label for="marriage1">独身</label>
									<input type="radio" name="Mrrg" id="Mrrg1" value="1" {if $Mrrg == "1"} checked {/if} />
									<label for="marriage2">既婚</label>
								</td>
							</tr>
							<tr>
								<th>ご職業</th>
								<td>
								<select name="JobKbn"  id="JobKbn">
									<option value="0" {if $JobKbn == "0"} selected="selected" {/if}>選択してください</option>
									<option value="1" {if $JobKbn == "1"} selected="selected" {/if}>会社員</option>
									<option value="2" {if $JobKbn == "2"} selected="selected" {/if}>学生</option>
									<option value="3" {if $JobKbn == "3"} selected="selected" {/if}>自営業</option>
									<option value="4" {if $JobKbn == "4"} selected="selected" {/if}>無職</option>
									<option value="5" {if $JobKbn == "5"} selected="selected" {/if}>フリーター</option>
									<option value="6" {if $JobKbn == "6"} selected="selected" {/if}>その他</option>
								</select>
								</td>
							</tr>
							<tr>
								<th>ご住所&nbsp;<span>[必須]</span></th>
								<td>
									<p>〒&nbsp;<input type="text" name="Zip1" value="{$Zip1}" id="Zip1" maxlength="3"  class="addnoInput required number"  style="IME-MODE: disabled" />－<input type="text" name="Zip2"  value="{$Zip2}" id="Zip2" maxlength="4"  class="addnoInput required number"  style="IME-MODE: disabled" /></p>
									<p class="pref01">都道府県&nbsp;
									<select name="PrefCd"  id="PrefCd"  class="required" >
										<option value="" {if $PrefCd == ""} selected="selected" {/if}>選択して下さい</option>
										<option value="01" {if $PrefCd == "01"} selected="selected" {/if}>北海道</option>
										<option value="02" {if $PrefCd == "02"} selected="selected" {/if}>青森県</option>
										<option value="03" {if $PrefCd == "03"} selected="selected" {/if}>岩手県</option>
										<option value="04" {if $PrefCd == "04"} selected="selected" {/if}>宮城県</option>
										<option value="05" {if $PrefCd == "05"} selected="selected" {/if}>秋田県</option>

										<option value="06" {if $PrefCd == "06"} selected="selected" {/if}>山形県</option>
										<option value="07" {if $PrefCd == "07"} selected="selected" {/if}>福島県</option>
										<option value="08" {if $PrefCd == "08"} selected="selected" {/if}>茨城県</option>
										<option value="09" {if $PrefCd == "09"} selected="selected" {/if}>栃木県</option>
										<option value="10" {if $PrefCd == "10"} selected="selected" {/if}>群馬県</option>
										<option value="11" {if $PrefCd == "11"} selected="selected" {/if}>埼玉県</option>

										<option value="12" {if $PrefCd == "12"} selected="selected" {/if}>千葉県</option>
										<option value="13" {if $PrefCd == "13"} selected="selected" {/if}>東京都</option>
										<option value="14" {if $PrefCd == "14"} selected="selected" {/if}>神奈川県</option>
										<option value="15" {if $PrefCd == "15"} selected="selected" {/if}>新潟県</option>
										<option value="16" {if $PrefCd == "16"} selected="selected" {/if}>富山県</option>
										<option value="17" {if $PrefCd == "17"} selected="selected" {/if}>石川県</option>

										<option value="18" {if $PrefCd == "18"} selected="selected" {/if}>福井県</option>
										<option value="19" {if $PrefCd == "19"} selected="selected" {/if}>山梨県</option>
										<option value="20" {if $PrefCd == "20"} selected="selected" {/if}>長野県</option>
										<option value="21" {if $PrefCd == "21"} selected="selected" {/if}>岐阜県</option>
										<option value="22" {if $PrefCd == "22"} selected="selected" {/if}>静岡県</option>
										<option value="23" {if $PrefCd == "23"} selected="selected" {/if}>愛知県</option>

										<option value="24" {if $PrefCd == "24"} selected="selected" {/if}>三重県</option>
										<option value="25" {if $PrefCd == "25"} selected="selected" {/if}>滋賀県</option>
										<option value="26" {if $PrefCd == "26"} selected="selected" {/if}>京都府</option>
										<option value="27" {if $PrefCd == "27"} selected="selected" {/if}>大阪府</option>
										<option value="28" {if $PrefCd == "28"} selected="selected" {/if}>兵庫県</option>
										<option value="29" {if $PrefCd == "29"} selected="selected" {/if}>奈良県</option>

										<option value="30" {if $PrefCd == "30"} selected="selected" {/if}>和歌山県</option>
										<option value="31" {if $PrefCd == "31"} selected="selected" {/if}>鳥取県</option>
										<option value="32" {if $PrefCd == "32"} selected="selected" {/if}>島根県</option>
										<option value="33" {if $PrefCd == "33"} selected="selected" {/if}>岡山県</option>
										<option value="34" {if $PrefCd == "34"} selected="selected" {/if}>広島県</option>
										<option value="35" {if $PrefCd == "35"} selected="selected" {/if}>山口県</option>

										<option value="36" {if $PrefCd == "36"} selected="selected" {/if}>徳島県</option>
										<option value="37" {if $PrefCd == "37"} selected="selected" {/if}>香川県</option>
										<option value="38" {if $PrefCd == "38"} selected="selected" {/if}>愛媛県</option>
										<option value="39" {if $PrefCd == "39"} selected="selected" {/if}>高知県</option>
										<option value="40" {if $PrefCd == "40"} selected="selected" {/if}>福岡県</option>
										<option value="41" {if $PrefCd == "41"} selected="selected" {/if}>佐賀県</option>

										<option value="42" {if $PrefCd == "42"} selected="selected" {/if}>長崎県</option>
										<option value="43" {if $PrefCd == "43"} selected="selected" {/if}>熊本県</option>
										<option value="44" {if $PrefCd == "44"} selected="selected" {/if}>大分県</option>
										<option value="45" {if $PrefCd == "45"} selected="selected" {/if}>宮崎県</option>
										<option value="46" {if $PrefCd == "46"} selected="selected" {/if}>鹿児島県</option>
										<option value="47" {if $PrefCd == "47"} selected="selected" {/if}>沖縄県</option>

										</select>
										</p>
										<p class="pref02"><input type="text" name="Address" value="{$Address}" id="Address"  class="normalInputLong required" maxlength="50" class="required" style="ime-mode:active" /></p>
										<p class="addressAttTxt">※誤配送防止のため、番地・ビル名・号室まで正確にご入力ください。</p>
										<p class="errTxt" htmlfor="Address" generated="true" />
										<p class="errTxt" htmlfor="zip" generated="true" />
									</td>
								</tr>
								<tr>
									<th>電話番号&nbsp;<span>[必須]</span></th>
									<td>
										<input type="text" name="Tel"  value="{$Tel}" id="Tel" maxlength="13" class="normalInput required numhifun"  style="ime-mode:inactive" />
										<p class="errTxt" htmlfor="Tel" generated="true" />
									</td>
								</tr>
								<tr>
									<th>FAX</th>
									<td>
										<input type="text" name="Fax" value="{$Fax}" id="Fax" maxlength="24" class="normalInput numhifun" style="ime-mode:inactive" />
										<p class="errTxt" htmlfor="Fax" generated="true" />
									</td>
								</tr>
								<tr>
									<th>メールアドレス</th>
									<td>
										<input type="text" name="Mail" value="{$Mail}" id="Mail" maxlength="50" class="normalInputLong email" style="IME-MODE: disabled" />
										<p class="errTxt" htmlfor="Mail" generated="true" />
									</td>
								</tr>
								<!-- ご意見･ご感想 -->
								<tr>
									<th>ご意見・ご感想</th>
									<td>
										<p class="textareaTitle">ご記入欄&nbsp;<span class="attTxt">（500文字以内）</span></p>
										<textarea name="Comment" id="Comment" cols="40" rows="10" style="ime-mode:active">{$Comment}</textarea>
									</td>
			       				</tr>
					       	</table>

						<div class="h2CmBlock02">
							<h2><span>アンケートにお答えください</span></h2>
						</div>

						<dl>
							<dt>Q1：お引越しの理由をお選びください。</dt>
							<dd>
								<table width="100%" border="0" cellspacing="0" cellpadding="0">
									<tr>
										<td width="24%">
											<input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu1" value="1" {if $HikkoshiRiyuu == "1"} checked {/if} />契約更新
										</td>
										<td width="22%">
											<input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu2" value="2" {if $HikkoshiRiyuu == "2"} checked {/if}/>独立
										</td>
										<td width="28%">
											<input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu3" value="3" {if $HikkoshiRiyuu == "3"} checked {/if}/>就職・転職
										</td>
										<td width="25%">
											<input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu4" value="4" {if $HikkoshiRiyuu == "4"} checked {/if}/>転勤
										</td>
									</tr>
									<tr>
										<td>
											<input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu5" value="5" {if $HikkoshiRiyuu == "5"} checked {/if}/>進学
										</td>
										<td>
											<input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu6" value="6" {if $HikkoshiRiyuu == "6"} checked {/if}/>結婚
										</td>
										<td>
											<input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu7" value="7" {if $HikkoshiRiyuu == "7"} checked {/if}/>子供の誕生・成長
										</td>
										<td>
											<input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu8" value="8" {if $HikkoshiRiyuu == "8"} checked {/if}/>狭くなった
										</td>
									</tr>
								</table>
								<p><input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu9" value="9" {if $HikkoshiRiyuu == "9"} checked {/if}/>周辺環境に不満</p>
								<p><input type="radio" name="HikkoshiRiyuu" id="HikkoshiRiyuu10" value="10" {if $HikkoshiRiyuu == "10"} checked {/if}/>その他
								<input type="text" name="HikkoshiRiyuuSonota" id="HikkoshiRiyuuSonota" value="{$HikkoshiRiyuuSonota}" class="otherInput" maxlength="20" /></p>
							</dd>
							<dt>Q2：今まで情報誌「アパマンショップ」を購入したことがありますか？</dt>
							<dd>
								<p><input type="radio" value="1" name="KounyuuKeiken" id="KounyuuKeiken1" {if $KounyuuKeiken == "1"} checked {/if}/>ある
								<input type="radio" value="2" name="KounyuuKeiken" id="KounyuuKeiken2" {if $KounyuuKeiken == "2"} checked {/if} />ない</p>
							</dd>
							<dt>Q3：情報誌「アパマンショップ」を知ったきっかけは？</dt>
							<dd>
								<p><input type="radio" value="1" name="Kikkake" id="Kikkake1" {if $Kikkake == "1"} checked {/if} />書店・コンビニで見て</p>
								<p><input type="radio" value="2" name="Kikkake" id="Kikkake2" {if $Kikkake == "2"} checked {/if} />知人からの紹介</p>
								<p><input type="radio" value="3" name="Kikkake" id="Kikkake3" {if $Kikkake == "3"} checked {/if} />アパマンショップのホームページを見て</p>
								<p><input type="radio" value="4" name="Kikkake" id="Kikkake4" {if $Kikkake == "4"} checked {/if} />TVCMを見て</p>
								<p><input type="radio" value="5" name="Kikkake" id="Kikkake5" {if $Kikkake == "5"} checked {/if} />その他
								<input type="text" name="KikkakeSonota" id="KikkakeSonota" value="{$KikkakeSonota}" class="otherInput" maxlength="20" />
								</p>
							</dd>
							<dt>Q4：情報誌「アパマンショップ」以外の賃貸情報誌をご覧になりましたか？</dt>
							<dd>
								<p><input type="radio" value="1" name="SonotaZassi" id="SonotaZassi1" {if $SonotaZassi == "1"} checked {/if} />はい　→　情報誌名
								<input type="text" maxlength="20" class="otherInput" name="SonotaZassiName" id="SonotaZassiName" value="{$SonotaZassiName}"/></p>
								<p><input type="radio" value="2" name="SonotaZassi" id="SonotaZassi2" {if $SonotaZassi == "2"} checked {/if}/>いいえ（情報誌「アパマンショップ」のみ）</p>
								<p><input type="radio" value="3" name="SonotaZassi" id="SonotaZassi3"{if $SonotaZassi == "3"} checked {/if} />賃貸情報誌は読んでいない</p>
							</dd>
							<dt>Q5：お部屋探しの際に重視する項目をお選びください。<span>（複数回答可）</span></dt>
							<dd>
								<table width="100%" cellspacing="0" cellpadding="0" border="0">
									<tr>
										<td width="33%">
											<input type="checkbox" value="1" name="JyuushiKoumoku1" id="JyuushiKoumoku1" {if $JyuushiKoumoku1 != ""} checked {/if}/>家賃
										</td>
										<td width="32%">
											<input type="checkbox" value="1" name="JyuushiKoumoku2" id="JyuushiKoumoku2" {if $JyuushiKoumoku2 != ""} checked {/if}/>間取
										</td>
										<td width="35%">
											<input type="checkbox" value="1" name="JyuushiKoumoku3" id="JyuushiKoumoku3" {if $JyuushiKoumoku3 != ""} checked {/if}/>駅からの距離（時間）
										</td>
									</tr>
									<tr>
										<td>
											<input type="checkbox" value="1" name="JyuushiKoumoku4" id="JyuushiKoumoku4" {if $JyuushiKoumoku4 != ""} checked {/if}/>駐車場の有無
										</td>
										<td>
											<input type="checkbox" value="1" name="JyuushiKoumoku5" id="JyuushiKoumoku5" {if $JyuushiKoumoku5 != ""} checked {/if}/>築年数
										</td>
										<td>
											<input type="checkbox" value="1" name="JyuushiKoumoku6" id="JyuushiKoumoku6" {if $JyuushiKoumoku6 != ""} checked {/if}/>周辺環境
										</td>
									</tr>
								</table>
								<p><input type="checkbox" value="1" name="JyuushiKoumoku7" id="JyuushiKoumoku7" {if $JyuushiKoumoku7 != ""} checked {/if}/>設備</p>
								<p><input type="checkbox" value="1" name="JyuushiKoumoku8" id="JyuushiKoumoku8" {if $JyuushiKoumoku8 != ""} checked {/if} />その他
								<input type="text" name="JyuushiKoumokuSonota" id="JyuushiKoumokuSonota" value="{$JyuushiKoumokuSonota}" class="otherInput" maxlength="20" /></p>
							</dd>
							<dt>Q6：情報誌「アパマンショップ」に掲載して欲しい物件の特集記事をお選びください。<span>（複数回答可）</span></dt>
							<dd>
								<p><input type="checkbox" value="1" name="NeedTokushuu1" id="NeedTokushuu1" {if $NeedTokushuu1 != ""} checked {/if} />新築物件</p>
								<p><input type="checkbox" value="1" name="NeedTokushuu2" id="NeedTokushuu2" {if $NeedTokushuu2 != ""} checked {/if}/>ペット相談可物件</p>
								<p><input type="checkbox" value="1" name="NeedTokushuu3" id="NeedTokushuu3" {if $NeedTokushuu3 != ""} checked {/if}/>ダブルゼロ（敷金・礼金ゼロ）物件</p>
								<p><input type="checkbox" value="1" name="NeedTokushuu4" id="NeedTokushuu4" {if $NeedTokushuu4 != ""} checked {/if}/>戸建て物件</p>
								<p><input type="checkbox" value="1" name="NeedTokushuu5" id="NeedTokushuu5" {if $NeedTokushuu5 != ""} checked {/if}/>デザイナーズアパート・マンション</p>
								<p><input type="checkbox" value="1" name="NeedTokushuu6" id="NeedTokushuu6" {if $NeedTokushuu6 != ""} checked {/if}/>その他
								<input type="text" name="NeedTokushuuSonota" id="NeedTokushuuSonota" value="{$NeedTokushuuSonota}" class="otherInput" maxlength="20" /></p>
							</dd>
						</dl>
						<!-- allInqBox -->

						<p id="privacyTxt">▼必ずお読みください。</p>
						<div id="privacyTitle">
							<p class="txt">個人情報の取り扱いについて</p>
							<p class="link"><a href="http://www.fcapamanshop.com/privacy.html" target="_blank">別ウィンドウで見る</a></p>
						</div>
						<div id="privacyContents">
							<iframe width="100%" scrolling="auto" height="165" frameborder="no" src="/app/html/inquiry/privacy.html" id="privacy"></iframe>
						</div>
						<table class="footTable">
							<tbody>
								<tr>
									<td></td>
									<td class="pointTxt">
										<a href="javascript:void(0);" onclick="javascript:magazineEntrySubmit(); return false;" class="links">入力内容を確認して送信</a>
									</td>
									<td>
										<a href="javascript:void(0);">
										<img width="271" height="66" class="rollImg" alt="「個人情報の取り扱いについて」に同意の上今すぐ送信" src="/images/search/detail/btn_send_now.jpg" onclick="javascript:magazineSendSubmit(); return false;" />
										</a>
									</td>
								</tr>
								<tr>
									<td colspan="3" class="attTd02">SSL暗号化通信を使用してますので、安心して個人情報を送信いただけます。</td>
								</tr>
							</tbody>
						</table>
					</div>
					<!-- /inqAllForm -->
				<!-- /contents -->
				</div>
				<!-- side -->
				<div id="side">
					<!-- sideNavi -->
					<div id="sideNavi">
						<ul class="first">
							<li><p><a href="{$baseurl}jyohoshi/shoukai.html">情報誌のご案内</a></p></li>
							<li><p><a href="{$baseurl}jyohoshi/katsuyou.html">情報誌120％活用法</a></p></li>
							<li><p><a href="{$baseurl}jyohoshi/mobile.html">モバイルで便利に</a></p></li>
							<li><p><a href="{$baseurl}jyohoshi/mikata.html">新生活の強い味方</a></p></li>
							<li class="current"><p><a href="{$sslurl}inquiry/magazineentry/">情報誌のお問い合わせ</a></p></li>
						</ul>
					</div>
					<!-- /sideNavi -->
				</div>
				<!-- /side -->
<!-- 共通パラメータここから -->
<input type="hidden" id="CntctWayFax" name="CntctWayFax" value="{$CntctWayFax}" />
<input type="hidden" id="CntctWayMail" name="CntctWayMail" value="{$CntctWayMail}" />
<input type="hidden" id="CntctWayTel" name="CntctWayTel" value="{$CntctWayTel}" />
<input type="hidden" id="CntctWayCd" name="CntctWayCd" value="{$CntctWayCd}" />
<input type="hidden" id="CntctWayStr" name="CntctWayStr" value="{$CntctWayStr}" />
<!-- <input type="hidden" id="Fax" name="Fax" value="{$Fax}" /> -->
<input type="hidden" id="Inquiry1" name="Inquiry1" value="{$Inquiry1}" />
<input type="hidden" id="Inquiry2" name="Inquiry2" value="{$Inquiry2}" />
<input type="hidden" id="Inquiry3" name="Inquiry3" value="{$Inquiry3}" />
<input type="hidden" id="Inquiry4" name="Inquiry4" value="{$Inquiry4}" />
<input type="hidden" id="Inquiry5" name="Inquiry5" value="{$Inquiry5}" />
<!-- <input type="hidden" id="Mail" name="Mail" value="{$Mail}" /> -->
<input type="hidden" id="MailMgznFlg" name="MailMgznFlg" value="{$MailMgznFlg}" />
<input type="hidden" id="Name" name="Name" value="{$Name}" />
<!-- <input type="hidden" id="NameMei" name="NameMei" value="{$NameMei}" /> -->
<!-- <input type="hidden" id="NameSei" name="NameSei" value="{$NameSei}" /> -->
<!-- <input type="hidden" id="KanaSei" name="KanaSei" value="{$KanaSei}" /> -->
<!-- <input type="hidden" id="KanaMei" name="KanaMei" value="{$KanaMei}" /> -->
<!-- input type="hidden" id="NeedTimeKbn" name="NeedTimeKbn" value="{$NeedTimeKbn}" /> -->
<!-- <input type="hidden" id="PlaceKbn" name="PlaceKbn" value="{$PlaceKbn}" /> -->
<input type="hidden" id="ShopCd" name="ShopCd" value="{$ShopCd}" />
<!-- <input type="hidden" id="Tel" name="Tel" value="{$Tel}" /> -->
<input type="hidden" id="UseKbn" name="UseKbn" value="{$UseKbn}" />
<input type="hidden" id="SrhKbn" name="SrhKbn" value="{$SrhKbn}" />
<input type="hidden" id="OemCd" name="OemCd" value="{$OemCd}" />
<input type="hidden" id="Url" name="Url" value="{$Url}" />
<input type="hidden" id="Company" name="Company" value="{$Company}" />
<input type="hidden" id="CtgryCd" name="CtgryCd" value="{$CtgryCd}" />
<input type="hidden" id="ClaimTgtKbn" name="ClaimTgtKbn" value="{$ClaimTgtKbn}" />
<!-- <input type="hidden" id="Mrrg" name="Mrrg" value="{$Mrrg}" /> -->
<input type="hidden" id="MrrgNm" name="MrrgNm" value="{$MrrgNm}" />
<input type="hidden" id="BuyExp" name="BuyExp" value="{$BuyExp}" />
<input type="hidden" id="BuyExpNm" name="BuyExpNm" value="{$BuyExpNm}" />
<!-- <input type="hidden" id="Comment" name="Comment" value="{$Comment}" /> -->
<input type="hidden" id="Other" name="Other" value="{$Other}" />
<input type="hidden" id="SiteKbn" name="SiteKbn" value="{$SiteKbn}" />
<!-- <input type="hidden" id="Address" name="Address" value="{$Address}" /> -->
<input type="hidden" id="Address1" name="Address1" value="{$Address1}" />
<input type="hidden" id="Address2" name="Address2" value="{$Address2}" />
<!-- <input type="hidden" id="JobKbn" name="JobKbn" value="{$JobKbn}" /> -->
<input type="hidden" id="JobNm" name="JobNm" value="{$JobNm}" />
<!-- <input type="hidden" id="Sex" name="Sex" value="{$Sex}" /> -->
<input type="hidden" id="SexNm" name="SexNm" value="{$SexNm}" />
<input type="hidden" id="Charge" name="Charge" value="{$Charge}" />
<input type="hidden" id="ChargeNm" name="ChargeNm" value="{$ChargeNm}" />
<input type="hidden" id="ChargeNmKana" name="ChargeNmKana" value="{$ChargeNmKana}" />
<input type="hidden" id="TenpoNm" name="TenpoNm" value="{$TenpoNm}" />
<input type="hidden" id="TenpoMail" name="TenpoMail" value="{$TenpoMail}" />
<!-- <input type="hidden" id="PrefCd" name="PrefCd" value="{$PrefCd}" /> -->
<input type="hidden" id="PrefName" name="PrefName" value="{$PrefName}" />
<!-- <input type="hidden" id="AgeKbn" name="AgeKbn" value="{$AgeKbn}" /> -->
<input type="hidden" id="AgeNm" name="AgeNm" value="{$AgeNm}" />
<input type="hidden" id="Busho" name="Busho" value="{$Busho}" />
<input type="hidden" id="BukkenCd" name="BukkenCd" value="{$BukkenCd}" />
<input type="hidden" id="Matrix" name="Matrix" value="{$Matrix}" />
<input type="hidden" id="Yakushoku" name="Yakushoku" value="{$Yakushoku}" />
<input type="hidden" id="Zip" name="Zip" value="{$Zip}" />
<!-- <input type="hidden" id="Zip1" name="Zip1" value="{$Zip1}" /> -->
<!-- <input type="hidden" id="Zip2" name="Zip2" value="{$Zip2}" /> -->
<input type="hidden" id="TargetKbn" name="TargetKbn" value="{$TargetKbn}" />
<input type="hidden" id="TargetNm" name="TargetNm" value="{$TargetNm}" />
<input type="hidden" id="ComId" name="ComId" value="{$ComId}" />
<input type="hidden" id="HikkoshiRiyuuText" name="HikkoshiRiyuuText" value="{$HikkoshiRiyuuText}" />
<!-- <input type="hidden" id="HikkoshiRiyuu" name="HikkoshiRiyuu" value="{$HikkoshiRiyuu}" /> -->
<!-- <input type="hidden" id="HikkoshiRiyuuSonota" name="HikkoshiRiyuuSonota" value="{$HikkoshiRiyuuSonota}" /> -->
<input type="hidden" id="NeedTokushuuText" name="NeedTokushuuText" value="{$NeedTokushuuText}" />
<input type="hidden" id="NeedTokushuu" name="NeedTokushuu" value="{$NeedTokushuu}" />
<!-- <input type="hidden" id="NeedTokushuuSonota" name="NeedTokushuuSonota" value="{$NeedTokushuuSonota}" /> -->
<input type="hidden" id="KounyuuKeikenText" name="KounyuuKeikenText" value="{$KounyuuKeikenText}" />
<!-- <input type="hidden" id="KounyuuKeiken" name="KounyuuKeiken" value="{$KounyuuKeiken}" /> -->
<input type="hidden" id="SonotaZassiText" name="SonotaZassiText" value="{$SonotaZassiText}" />
<!-- <input type="hidden" id="SonotaZassi" name="SonotaZassi" value="{$SonotaZassi}" /> -->
<!-- <input type="hidden" id="SonotaZassiName" name="SonotaZassiName" value="{$SonotaZassiName}" /> -->
<input type="hidden" id="SoufuKibouJyouhoushiText" name="SoufuKibouJyouhoushiText" value="{$SoufuKibouJyouhoushiText}" />
<!-- <input type="hidden" id="SoufuKibouJyouhoushi" name="SoufuKibouJyouhoushi" value="{$SoufuKibouJyouhoushi}" /> -->
<input type="hidden" id="KikkakeText" name="KikkakeText" value="{$KikkakeText}" />
<!-- <input type="hidden" id="Kikkake" name="Kikkake" value="{$Kikkake}" /> -->
<!-- <input type="hidden" id="KikkakeSonota" name="KikkakeSonota" value="{$KikkakeSonota}" /> -->
<input type="hidden" id="JyuushiKoumokuText" name="JyuushiKoumokuText" value="{$JyuushiKoumokuText}" />
<input type="hidden" id="JyuushiKoumoku" name="JyuushiKoumoku" value="{$JyuushiKoumoku}" />
<!-- <input type="hidden" id="JyuushiKoumokuSonota" name="JyuushiKoumokuSonota" value="{$JyuushiKoumokuSonota}" /> -->
<input type="hidden" id="FavFlg" name="FavFlg" value="{$FavFlg}" />
<input type="hidden" id="Did" name="Did" value="{$Did}" />
<input type="hidden" id="Sid" name="Sid" value="{$Sid}" />
<input type="hidden" id="UAKbn" name="UAKbn" value="{$UAKbn}" />
<input type="hidden" id="CampaignLocationFlg" name="CampaignLocationFlg" value="{$CampaignLocationFlg}" />
<input type="hidden" id="TimeStr" name="TimeStr" value="{$TimeStr}" />
<!-- 共通パラメータここまで -->
			</div>
			<!-- /contentsBlock -->
		</div>
		<!-- /siteContents -->
		<!-- InstanceEndEditable -->
	</div>